NBME 1 Block 2 discussion - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 02-21-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 223 Times in 119 Posts
Reputation: 233
Arrow NBME 1 Block 2 discussion

Boy what a tough block!!! Picked up a whole bunch of new concepts.


Q 6:

I think the right answer is E. I know we can calculate it for 1 year by dividing the 2 year calculation in half but that is not accurate at all. For a 1 year incidence you have to know how many accidents took place in that specific year and what the population at risk was for that specific year. We are only given info for a 2 year period hence we cannot accurately calculate for a 1 year period.


Q 16:

In case you were wondering what all the letters represent

A- Vertebrae..from the Sclerotome part of the SOMITES
B- Spinal cord (no longer neural tube Neural Tube)...5 weeks gone
C- Nucleus Pulposus (Nucleus pulposus is anterior to Spinal Cord)
D- Aorta (anterior to vertebral body and nucleus pulposus)
E- Dorsal Mesentery (part of mesoderm and has communication with the AORTA)
F- Endoderm of the primitive GUT
G- Bone of upper limb...From the Sclerotome part of the SOMITES
H- Hypoaxial Muscles(Extensors)...from the MYOTOME part of the sclerotome ...Note then the unlabeled structures below G are Hypoaxial muscles (flexors)...also from Myotome part of the SOMITES

I- Dermatome, the future dermis...From the dermatome part of the SOMITES


Q 25:

I thought it was a good answer to explain.

multidrug resistance to chemotherapeutic drugs such as (vincristine, doxorubicin, dactinomycin) occurs due to stepwise selection and amplification of gene that codes for a transmembrane protein (P-glycoprotein). This transmembrane P-protein is ATP-dependent pump, which has six membrane spanning loops forming a central channel for pumping of drugs from the cell.
Note: P-glycoprotein is normally expressed at low levels in most cell types.

resistance to methotrexate can be due to:
a) amplification (production of additional copies) of the gene that codes for dihydrofolate reductase resulting in increased levels of this enzyme
b) diminishing dihydrofolate reductase affinity for MTX
c) reduced influx of MTX, caused by a change in the carrier-mediated transport responsible for pumping methotrexate into the cell


Q 28:

I think the right answer is E. They are asking about Positive Predictive Value in the stem and Specificity as we know has greatest influence on PPV.


Q 42:

The right answer is F, pleural effusion. Everything is decreased and percussion is dull.
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr. Mexito (06-04-2012), drhouse (08-20-2014), israaoday (09-12-2014), jinni (02-22-2012), rose (02-22-2012)



  #2  
Old 02-22-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 175
Threads: 18
Thanked 63 Times in 48 Posts
Reputation: 73
Default

Q 6

Yes i too marked E and what you are saying is absolutely right.
I think E is the correct answer.

Q 16
When i saw the question i was like . you made it so clear, if you like to have a clear concept of development of muscular system you can read the same chapter in HY Embryology.

Q 25
Thanks Yes similar concept to UW

Q 28
PPV of a test is directly proportional to Prevalence of the disease so i think Prevalence is correct.
Quoting a line from FA page 51
if the prevalence of disease is low even tests with high specificity will have low PPV.

Q 42
Key is wrong here Yes its Pleural effusion.


Can you pls explain the following

Q 15
I had guessed E coz IL 1 is responsible for expression of adhesion molecules on endothelium responsible for neutrophil leukocytes.
Can you pls Explain how can it effect T lymphocyte function i think IL 2 is responsible for that.

Q 32

I think since he is a physician and senior to the residents he would first go and acess the charts of the patient and then advice them to discuss in private . I choose B
Pls Explain

Q 44
I choose Cystic hygroma, i have clearly written in my notes that Cystic hygroma lies posterior to SCM & have watery fluid in them while branchial cyst lies anterior to the SCM and have pale mucoid fluid inside it.
I think key is wrong here

Yes i think this was a tough block.
Reply With Quote Quick reply to this message
The above post was thanked by:
drhouse (08-20-2014)
  #3  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 223 Times in 119 Posts
Reputation: 233
Default

Quote:
Originally Posted by jinni View Post
Q 15
I had guessed E coz IL 1 is responsible for expression of adhesion molecules on endothelium responsible for neutrophil leukocytes.
Can you pls Explain how can it effect T lymphocyte function i think IL 2 is responsible for that.
Ok so this was not given in FA. Another role of IL-1 is that it is a stimulator of IL-2, and as you know IL-2 stimulates the growth of T Cells. You might wanna add this to FA.


Quote:
Originally Posted by jinni View Post
Q 32

I think since he is a physician and senior to the residents he would first go and acess the charts of the patient and then advice them to discuss in private . I choose B
Pls Explain
This is a question examining Doctor-Patient relationship. Basically regardless of what you do with a patient, you should not be talking about it in public. The patient's information should stay private. Anyone could have overheard this conversation.


Quote:
Originally Posted by jinni View Post
Q 44
I choose Cystic hygroma, i have clearly written in my notes that Cystic hygroma lies posterior to SCM & have watery fluid in them while branchial cyst lies anterior to the SCM and have pale mucoid fluid inside it.
I think key is wrong here

Yes i think this was a tough block.
I don't think that there is a set position for either. I've looked at descriptions and pictures and either could occur in any lateral position, be it anterior posterior to SCM. The way the stem describes it is definetely Branchial Cyst. If they wanted to test cystic hygroma they probably would have added something else cuz it says no other abnormality is present.
Reply With Quote Quick reply to this message
The above post was thanked by:
drhouse (08-20-2014)
 
  #4  
Old 02-22-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 644 Times in 408 Posts
Reputation: 654
Default

hey guys let me know when you plan on doing form 2 offline
i'll do it as well as discuss with you guys
i did form1 but am too lazy to go find my answers
although i do remember #6 and i marked E as well lol
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message
  #5  
Old 02-22-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by khushi.chahal View Post
hey guys let me know when you plan on doing form 2 offline
i'll do it as well as discuss with you guys
i did form1 but am too lazy to go find my answers
although i do remember #6 and i marked E as well lol

we have already done nbme 2 , may be you can join in for nbme block 1 tomorrow or nbme 3 ......
Reply With Quote Quick reply to this message
  #6  
Old 02-22-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 644 Times in 408 Posts
Reputation: 654
Default

Quote:
Originally Posted by Hitman View Post
we have already done nbme 2 , may be you can join in for nbme block 1 tomorrow or nbme 3 ......
I'll find my form1 answers tonight and join in on the convo, thus far and that coming up with block 1.
When are you guys doing form 3? You guys are doing one block at a time?
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message
  #7  
Old 02-22-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by khushi.chahal View Post
I'll find my form1 answers tonight and join in on the convo, thus far and that coming up with block 1.
When are you guys doing form 3? You guys are doing one block at a time?
yes a block per day .....
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr.NickRiviera (02-22-2012)
  #8  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 226
Threads: 60
Thanked 29 Times in 23 Posts
Reputation: 39
Default

hi
Q 32 me too I choose d I think he has to save the patient first

Q 41 I choose E , why not obtruction

Q46 , I choose a as this is maternal inhereted disease , and as i understood he asked about future generation of NO.9 !!!

Q 42 yes it is F

Q44 @jinni , yes he mentioned that he / she is healthy

Q 49 why not costal pleura???
Reply With Quote Quick reply to this message
  #9  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 223 Times in 119 Posts
Reputation: 233
Default

Quote:
Originally Posted by rose View Post
Q 41 I choose E , why not obtruction
Involuntary guarding and rebound tenderness is classic peritonitis. Additionally lack of bowel sounds means paralytic ileus which is also a sign of peritonitis. In obstruction there are increased bowel sounds with the GI trying to push against the obstruction, which later on develops into absent of bowel sounds.


Quote:
Originally Posted by rose View Post
Q46 , I choose a as this is maternal inhereted disease , and as i understood he asked about future generation of NO.9 !!!
it is mitochondrial disease as you said spread through maternal inheritance. All males of affected/carrier women will have the disease. They are asking if child 9 in the 4 generation will have the disease and he will most definitely have it, 100%.


Quote:
Originally Posted by rose View Post
Q 49 why not costal pleura???
It should not be present at that level. Remember the incision will be very close to the kidney.
Reply With Quote Quick reply to this message
The above post was thanked by:
rose (02-22-2012)
  #10  
Old 02-22-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Q 6

its E

Q 42 Yes its Pleural effusion.

Qs 32 F ..... its a rule not to discuss patient matters outside ...... so its necessary to stop them , that is all he can do , he has no business to enter in someone elses medical care , those residents definitely have a Attending to take care of it .....

Qs 46 the ans is A ....... the key is wrong here .....

Qs 49 .costal pleura is very much above the level of the kidney , so its not going to be damaged , kidneys are retroperitoneal so no peritoneal damage either .....

Qs 15 .. IL 1 is a costimulator for t cells and chemotactic for macrophage and neutrophils ..

Qs 44 ..... cystic hygromas are multi locular and contain lymph ..this was watery and unilocular .....

pls could you explain Qs 12 ......

thanks.
Reply With Quote Quick reply to this message
The above post was thanked by:
drhouse (08-20-2014), rose (02-22-2012)
  #11  
Old 02-22-2012
Hitman's Avatar
USMLE Forums Master
 
Steps History: Not yet
Posts: 928
Threads: 17
Thanked 539 Times in 375 Posts
Reputation: 549
Default

Quote:
Originally Posted by haga View Post

it is mitochondrial disease as you said spread through maternal inheritance. All males of affected/carrier women will have the disease. They are asking if child 9 in the 4 generation will have the disease and he will most definitely have it, 100%.

the Qs says that the male no 9 in 4 generation is marrying a normal partner will HIS child have the disease the ans is NO .its 0 % .......the key is wrong here .........
Reply With Quote Quick reply to this message
The above post was thanked by:
drhouse (08-20-2014)
  #12  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 226
Threads: 60
Thanked 29 Times in 23 Posts
Reputation: 39
Default

@haga thanks alot

@hitman in Q 12 since he mention that there is increase in HLA type this has means MHC II failed to express the antigen
Reply With Quote Quick reply to this message
  #13  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 226
Threads: 60
Thanked 29 Times in 23 Posts
Reputation: 39
Default

Quote:
Originally Posted by Hitman View Post
the Qs says that the male no 9 in 4 generation is marrying a normal partner will HIS child have the disease the ans is NO .its 0 % .......the key is wrong here .........
yes that is what he meant , he does not ask about the child he no . 9 as the pedigree clears that he already has the disease
Reply With Quote Quick reply to this message
  #14  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 223 Times in 119 Posts
Reputation: 233
Default

Quote:
Originally Posted by Hitman View Post
the Qs says that the male no 9 in 4 generation is marrying a normal partner will HIS child have the disease the ans is NO .its 0 % .......the key is wrong here .........
I always make this kind of mistake in misreading the question, drives me crazy.

Thanks for clearing the confusion.
Reply With Quote Quick reply to this message
The above post was thanked by:
jinni (02-22-2012)
  #15  
Old 02-22-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 644 Times in 408 Posts
Reputation: 654
Default

yea #46 is A
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message



  #16  
Old 02-22-2012
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,406
Threads: 118
Thanked 644 Times in 408 Posts
Reputation: 654
Default

can somebody explain to me:
#12, #32, #42 (pleural effusion vs. pneuomothorax)
__________________
"inflammable means flammable!? What a country."
Reply With Quote Quick reply to this message
  #17  
Old 02-22-2012
USMLE Forums Veteran
 
Steps History: Not yet
Posts: 270
Threads: 34
Thanked 223 Times in 119 Posts
Reputation: 233
Default

Quote:
Originally Posted by Dr.NickRiviera View Post
can somebody explain to me:
#12, #32, #42 (pleural effusion vs. pneuomothorax)
Q12:

Whenever a foreign particle enters the body it is phagocytosed by antigen presenting cells (APCs). APCs are macrophages, dendritic cells and B cells. They present the foreign antigen on MHC II which is then recognized by the Th cell which produce cytokines. This is the mechanism for producing immunity.


Q32:

They are trying to test if you know about Doctor-Patient confidentiality. Hitman described it best.

"its a rule not to discuss patient matters outside ...... so its necessary to stop them , that is all he can do , he has no business to enter in someone elses medical care , those residents definitely have a Attending to take care of it"


Q42:

The way to differentiate Pneumothorax and Effusion is through percussion. In a normal lung air is present which is resonant on percussion. A Pneumothorax would be hyperresonant since there is more air present and usually the lung tissue is collapsed. In Effusion there is fluid in the lungs and fluid will never be resonant on percussion, it will be dull.

Now both consolidation and Effusion are dull on percussion. The way to differentiate these 2 is vocal and tactile fremitus. In consolidation both are increased while in Effusion both are decreased.
Reply With Quote Quick reply to this message
The above post was thanked by:
Dr. Mexito (06-03-2012), Dr.NickRiviera (02-22-2012), drhouse (08-20-2014), pkul85 (03-26-2012)
  #18  
Old 02-22-2012
USMLE Forums Addict
 
Steps History: Not yet
Posts: 175
Threads: 18
Thanked 63 Times in 48 Posts
Reputation: 73
Default

Quote:
Originally Posted by haga View Post

I don't think that there is a set position for either. I've looked at descriptions and pictures and either could occur in any lateral position, be it anterior posterior to SCM. The way the stem describes it is definetely Branchial Cyst. If they wanted to test cystic hygroma they probably would have added something else cuz it says no other abnormality is present.
Cystic hygroma classicaly occur over the posterior triangle but yes both can occur anywhere.
I am sure cystic hygroma contains watery fluid while branchial cyst has cholesterol crystals and keratin debris in it.
http://en.wikipedia.org/wiki/Cystic_hygroma
http://en.wikipedia.org/wiki/Branchial_cleft_cyst
I stiil think its cystic hygroma
Reply With Quote Quick reply to this message
  #19  
Old 08-23-2015
USMLE Forums Scout
 
Steps History: CS Only
Posts: 40
Threads: 21
Thanked 2 Times in 2 Posts
Reputation: 12
Default Q19

why not histiocytosis X ,yes wegner's has necrotizing vasculitis but does it has histiocytes ?
Reply With Quote Quick reply to this message



Reply

Tags
NBME-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
NBME 5 Block 3 discussion haga USMLE Step 1 Forum 24 06-18-2014 08:24 AM
NBME 5 Block 2 discussion haga USMLE Step 1 Forum 31 05-30-2014 11:31 AM
NBME 6 Block 1 discussion haga USMLE Step 1 Forum 32 09-02-2012 05:14 PM
NBME 1 Block 1 discussion haga USMLE Step 1 Forum 33 02-23-2012 06:35 PM
NBME 1 Block 1 discussion Hitman USMLE Step 1 Forum 24 02-23-2012 02:00 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)